- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $7,585.78
| Facility | | $758.58 | $2,454.71 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $10,471.29 / $16,595.87
| Facility | | $2,691.53 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $13,803.84 / $19,952.62
| Facility | | $12,589.25 | $13,803.84 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $75,857.76 / $75,857.76
| Facility | | $54.95 | $75,857.76 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $12,022.64 / $26,915.35
| Facility | | $6,456.54 | $12,022.64 | $26,915.35 |